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(j '0 2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR TNTERNAL USE ONLY
Date Received:
Chris Masterson 0
Christine Fulton ._~
Sue Rose 23
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Received by:
FOIL Ser. #: 117
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W ATERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEP ARTMEN'I USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
---
Date:
/ /
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Date FOIL fulfilled or denied:
Closed by:
Notes:
Amount Due3- Pages for a total of $ I 7s-c\
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (4/Lf
Email address: (YJO
)--
SPECIFIC DESCRIPTION OF REC
Lit
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FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record( s) described above
~ I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above